A nationwide study on inpatient opportunistic infections in patients with chronic lymphocytic leukemia in the pre-ibrutinib era
A nationwide study on inpatient opportunistic infections in patients with chronic lymphocytic leukemia in the pre-ibrutinib era
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DOI：
10.1111/ejh.13553
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发表时间：
2020-12-03
影响因子：
3.1
通讯作者：
Kristinsson, Sigurdur Y.
中科院分区：
文献类型：
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作者：
Steingrimsson, Vilhjalmur;Gislason, Gauti Kjartan;Kristinsson, Sigurdur Y.
目的慢性淋巴细胞白血病（CLL）患者的病原体感染已在临床试验、单中心研究和病例报告中描述。我们进行了一项全国性研究，以估计住院机会性感染的发生率和影响。方法计算1994-2013年诊断的瑞典CLL患者和匹配对照的发病率（IR）和发病率比（IRR），以及病死率（CFR）。结果在8989例CLL患者中，共登记了829例机会性感染（IR为16.6/1000人-年），而34283例匹配对照中有252例机会性感染（IR为0.99）。CLL队列中发生率最高的是肺孢子虫肺炎（200例感染，IR 4.03）、带状疱疹（146例感染，IR 2.94）和假单胞菌（83例感染，IR 1.66）感染。观察到肺孢子虫肺炎相对于匹配对照的最高风险（IRR 114，95%置信区间58.7-252）。慢性淋巴细胞白血病合并机会性感染患者的60 d病死率为23%（188/821），以进行性多灶性脑病（5/7，71%）和曲霉病（25/60，42%）最高。在最常见的机会性感染中，伴曲霉菌病的CLL患者预后最差。
Objective Opportunistic infections in chronic lymphocytic leukemia (CLL) have been described in clinical trials, single-center studies, and case reports. We performed a nationwide study to estimate the incidence and impact of inpatient opportunistic infections.Methods The incidence rate (IR) and incidence rate ratio (IRR) for Swedish CLL patients diagnosed 1994-2013, and matched controls were calculated, as well as the case-fatality ratio (CFR).Results Among 8989 CLL patients, a total of 829 opportunistic infections were registered (IR 16.6 per 1000 person-years) compared with 252 opportunistic infections in 34 283 matched controls (IR 0.99). The highest incidence in the CLL cohort was for Pneumocystis pneumonia (200 infections, IR 4.03); Herpes zoster (146 infections, IR 2.94), and Pseudomonas (83 infections, IR 1.66) infections. The highest risk relative to matched controls was observed for Pneumocystis pneumonia (IRR 114, 95% confidence interval 58.7-252). The 60-day CFR for CLL patients with opportunistic infections was 23% (188/821), highest for progressive multifocal encephalopathy (5/7, 71%) and aspergillosis (25/60, 42%).Conclusion We have uniquely depicted the incidence of rare and serious infections in CLL patients and found a relatively high incidence of Pneumocystis pneumonia. Of the most common opportunistic infections, CLL patients with aspergillosis had the poorest prognosis.